Flu, Covid, and R.S.V. Vaccines for Fall: Who Should Get Them and When?

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Most Americans have already received their flu and Covid vaccines, but this year there’s a new addition to the lineup: shots to protect older adults from respiratory syncytial virus (RSV). Health officials are optimistic that the widespread use of these three vaccines will help prevent another wave of respiratory illnesses, similar to what was seen last winter. The goal is to avoid a “tripledemic” of flu, Covid, and RSV. Additionally, for those with insurance, all three vaccines should be available for free. 

According to the New York Times, Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital, referred to the availability of these vaccines as an “embarrassment of riches.” With this in mind, experts are providing guidance on who should receive each vaccine and when. The upcoming fall season is expected to bring resurgences of the coronavirus, flu, and RSV.

However, due to the pandemic restrictions, the seasonal patterns of these viruses have been altered. Last winter, the flu peaked in December instead of February, causing a higher number of deaths, estimated to be around 58,000. Covid infections and deaths remained steady throughout the season, with a peak in January. 

In the case of RSV, it peaked earlier than usual and circulated for a longer period. This lesser-known virus is increasingly recognized as a significant respiratory threat, especially for older adults, immunocompromised individuals, and young children. Its disease burden is comparable to that of the flu in older adults. 

Experts anticipate that respiratory viruses will eventually return to their pre-pandemic patterns, but for the next couple of years, their behavior will remain unpredictable. In light of this uncertainty, experts recommend that everyone receives at least the flu and Covid shots this fall. The annual flu vaccine is advised for individuals aged 6 months and older, but it is particularly important for adults aged 65 and older, children under 5, and those with weakened immune systems. Updated Covid shots, targeting the Omicron variant, will be available from Pfizer, Moderna, and Novavax. The specific recommendations will be provided once the FDA authorizes the shots and the CDC reviews the new data. 

Rather than discussing a primary series of shots followed by boosters, health officials are now encouraging Americans to think of a single annual immunization with the latest version of the vaccine, similar to using a seatbelt in a car. The Covid vaccine, for example, should be considered for annual use. R.S.V. poses a significant respiratory threat to older adults, especially those aged 75 and older with underlying conditions such as cardiovascular disease, chronic lung disease, or diabetes. However, it’s crucial to note that even individuals without pre-existing conditions can become seriously ill from any of these three viruses. 

Regarding the timing of the vaccines, since the exact resurgence of these viruses is unknown, it is recommended to receive the shots early enough in the fall to allow for the development of immunity. To minimize the need for multiple clinic visits, most Americans should consider receiving the flu and Covid shots simultaneously. Older adults in poor health are advised to receive all three shots together. Experts suggest getting vaccinated in September or October. For individuals aged 50 and older, the shingles vaccine should be considered if not already received, while those aged 65 and older should schedule a pneumococcal vaccine. However, these vaccines do not need to be administered in the fall and can be scheduled for a different time. 

As for the safety of receiving these vaccines together, last fall saw many individuals receiving the flu and Covid shots concurrently without any major safety concerns. Since the R.S.V. vaccine is new, limited data is available on its interaction with the other two vaccines. However, according to the Department of Health and Human Services, no safety concerns have been identified regarding the administration of influenza andCovid-19 vaccines together. Vaccine safety monitoring systems will continue to be in place to identify any potential safety signals, and further assessments will be conducted if needed. 

Some research suggests that when the R.S.V. and flu vaccines are given together, they may produce lower levels of antibodies compared to when administered separately. However, experts believe that these antibody levels are still sufficient to provide protection against the viruses. Regarding the safety of R.S.V. vaccines, there is limited data available.

During clinical trials, six cases of neurological problems, including Guillain-Barré syndrome, were recorded among vaccinated individuals, while none were reported in the placebo groups. However, the small number of cases makes it difficult to determine if these issues were directly caused by the vaccines. More information will be gathered through surveillance as the vaccines are administered on a larger scale. 



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